The Development of Admiral Nursing within a Local Authority Setting. Amy Pepper (Admiral Nurse Clinical Lead) Sandra Roche (Service Manager)

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Marian Lewis
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1 The Development of Admiral Nursing within a Local Authority Setting Amy Pepper (Admiral Nurse Clinical Lead) Sandra Roche (Service Manager)

2 What are Admiral Nurses? We are specialist dementia nurses with extensive experience working with people with dementia and their carers We use a range of clinical skills and interventions to improve the quality of life of the carer, the person with dementia and the wider family unit. We focus on providing relationship centred care to help families live well with dementia

resolving conflicts Liaising with other professionals and linking up the care pathway Help managing unpredictable/challenging symptoms

3 What support can Admiral Nurses offer families? A comprehensive and holistic assessment Assessing risk and promoting positive management Working with complex family dynamics and resolving conflicts Liaising with other professionals and linking up the care pathway Help managing unpredictable/challenging symptoms Education and building skills Working with families who cannot access other services easily Advice on medications Planning for End of Life and post bereavement support Emotional support for carers Support at transition points

4 Admiral Nursing at London Borough of Sutton How the service came about...

5 Beginnings... Family experience Nan had dementia Tresham Resource Centre WCC Tom Kitwood inspired loss of identity

6 Experiences of Dementia Statutory Social Work Poor understanding of person centred approaches Discriminatory language, depersonalisation Refer to CMHT He has dementia what do you expect? Family breakdown I can t be expected to live like this

7 Local Leadership Reclaiming Social Work The chequebook approach wasn t working Attachment based practice instead of resource allocation Values of reclaiming social work agenda in tune with best practices in dementia care Head of service passionate about improving dementia services

8 Challenges of setting up the service

9 Seize the Day! End of March k re-ablement transfer from health to the council Integration and prevention of hospital admissions driving policy Thesis that and Admiral Nursing Service would be able to reduce admissions and improve outcomes for families Test It!

10 Ask forgiveness not permission! Steering group GP dementia lead, OP Psych, Carers Centre, AS, CCG commissioner and Ann carer Service specification, memorandum of understanding, job description (Dementia UK provide clinical governance and CPD) Risk established post although funding insecure Belief - that we could prove the concept Band 7 nurse to lead the test and learn

11 Here comes Amy... 3 months scoping Formal Launch Continuous evaluation from outset

12 Scoping the Service Filling in the gaps...

13 Age UK Alzheimer s Society Sutton and Merton Community Services Carer s Centre Person/family living with dementia GP s OPCMHT London Borough of Sutton Epsom and St Hellier University Hospitals Trust

14 Identified Gaps Where complex liaison with other agencies is required Carer needs specialist nursing intervention to manage psychological and emotional wellbeing Conflict between person with dementia and carer/family Where there is a high risk of carer breakdown and support is needed to help them continue in or relinquish their caring role

15 Evaluating the Service Proving our worth...

16 Adult Carer Quality of Life Questionnaire Support for Caring Money Matters Caring Choice Personal Growth Ability to Care Caring Stress Sense of Value

17 Retrospective caseload analysis Retrospective evaluation of caseload to identify cases where there was a high risk of resource use as in Norfolk evaluation model Attaching costs to these cases based on local figures

18 Results from the first year Improving quality of life and saving money

19 Outcomes over the first year 84 families seen by the service in the first year All carers showed an increase in self reported quality of life Biggest increases in Support for Caring and Ability to Care subscales Carers feeling better supported and more confident and competent in caring

20 Retrospective evaluation Significant cost savings to health and social care Those who were not high users of services but were high risk did not start using services Correlation with the findings of the AC-QoL and increase in Ability to Care

21 The Benefits of Admiral Nursing in a Local Authority How the service has benefitted families and colleagues

22 Support with Safeguarding Supporting and advising colleagues Supporting families to stay together Making safeguarding more about supporting and less about punitive measures

23 Meet Larry and Michael... Referred to Admiral Nurse following safeguarding concerns Allegation of abuse from carer bruises and fractures Time spent with carer identified poor manual handling due to lack of skills/knowledge Support plan put in place to support practically and emotionally Family able to stay together rather than a move to care home

24 Moving Forward

25 Further work for the service CCG have approved funding for three more posts Providing more bespoke training to LA staff and further afield Consultancy/practice development work in the general hospital Expanding on the evaluation qualitative data

26 Admiral Nursing it just works A model that works for families Fills gaps in service provision Proven value in terms of quality and cost effectiveness Versatile model Clear benefits for the Local Authority

28 Thank you for listening

29 For more information... Amy Pepper Sandra Roche Dementia UK

Dementia End of Life Facilitation Team Admiral Nurse Band 6 Job Description

Dementia End of Life Facilitation Team Admiral Nurse Band 6 Job Description Job Title: Grade: Band 6 Base: Hours: 37.5 Managerially accountable to Professionally responsible to : Dementia EoLF Team Admiral